Hospice offers peace for last days

Jerry McCrea/The Star-LedgerNurse Corinne Temple has become close with patient, Tanya Landeros during her hospice care at Peggy Coloney's House at The Center for Hope in Scotch Plains.

Gaile Keegan rolled her wheelchair past the split-rail fence, the roses and lilac tree and the Japanese garden.

"Isn't it lovely?" she asked, turning her face toward the breeze. "I come here to reflect."

The 60-year-old woman expects to spend her last days at this new hospice in Scotch Plains, where she sleeps in a private room and spends time in the library, or by the fireplace in the living room.

Does she feel at peace?

"I'm still working on that," she said with a wry smile.

Keegan, a New Providence woman with tumors in her lung and liver, lives at New Jersey's newest free-standing hospice, a 30-bed facility called Peggy Coloney's House, designed to give terminally ill patients a dignified and pain-free end to their lives.

It opened this year and shows both the promise and challenges of hospice care in New Jersey, a state with the nation's most aggressive end-of-life medical care.

Hospice workers say they often feel they are swimming against the current in New Jersey, where chronically ill patients are more likely to die in the hospital or intensive care unit than patients in any other state.

"There is such an over-abundance of care in New Jersey that patients get referred to hospice later and later all the time," said Donald L. Pendley, president of the New Jersey Hospice and Palliative Care Organization. "But sometimes the last thing patients need is one more dose of chemo before they die."

Pendley said the average hospice patient in the United States spends 25 days in hospice. In New Jersey, the figure is 17. The Dartmouth Atlas of Health Care, a national database, found that chronically ill Medicare patients in New Jersey spend 30 percent less on hospice in the last six months of life than the national average.

Most hospice care in New Jersey is provided at home, and many hospitals have hospice wings for dying patients. The new Peggy Coloney's House, named for the woman who co-founded the Center for Hope Hospice and Palliative Care in 1983, is unusual because it was designed and built solely as a hospice.

So far, though, officials at the hospice, which opened in January, said they continue to get patients referred to them who are very close to death. Hospice workers say they want more time to work with patients to ease their physical pain and to help them and their families deal with grief and bereavement.

"Unfortunately, our average length of stay is only 10 days," said Robert J. Coloney, the CEO of the Center for Hope, which runs the hospice. He is the son of Peggy Coloney, who died in 2003.

Hospice workers said doctors and families often avoid candid talk about death and pursue futile diagnostic tests or procedures.

"I go and give talks and doctors nod, but then things do not necessarily change," said Robert Wegryn, the medical director of the Center for Hope. "Some doctors get it. Some call you at the last heartbeat."

Keegan was working as an administrative assistant at Schering-Plough when she was diagnosed with cancer. She said she is grateful that her doctor talked to her candidly about hospice as her disease progressed. She moved there just two weeks ago.

"It was not easy to take," she recalled of that conversation. "How do you react when someone says you are going to die? But it was appreciated."

She talked as she moved around the facility, which is built with stone and natural woods and decorated in warm colors. Sunlight filled a sitting room and a nearby dining area.

Keegan lived alone and could no longer care for herself. Now, she said the nurses get her everything she wants. "They are warm and attentive," she said. "I feel guilty asking for anything."

She said her son, who works full-time, knows that she is well cared for and comfortable. "I can tell by his reaction that he feels a lot better that I am here," she said.

Peggy Coloney (pronounced Ca-LONE-ee) began planning the facility before she died of pancreatic cancer. She wanted the hospice to be like a home, not a hospital, her son said. There are three guest rooms if family members stay overnight, and a play area for visiting children.

"This was my mother's dream," Robert Coloney said.

He said the center has had 77 referrals since it opened in January and 57 admissions. Some referrals were so late the patients died before being transferred.

Medicare will pay for hospice if doctors believe a person will likely live only six more months, although payments will continue if patients live longer.

Medicare covers the $160 a day medical charge for Peggy Coloney's House. Patients are changed an additional $290 a day for room and board, based on their ability to pay, Coloney said. Some patients at the hospice have been wealthy; some have been homeless.

The $11 million center was built with federal, state, county and private dollars.

Coloney said the center works to educate physicians about hospice. For instance, many doctors do not know that they can continue to follow their patients at the hospice and bill Medicare for their services.

In the living area of the house one recent day, an elderly woman played the piano. Nearby, Michael F. Richel, 82, sat on a couch, in hat, suit coat and scarf, and talked about his life as an insurance salesman.

"It's a nice atmosphere and mentally a place to ease my mind," said Richel, a lifelong Elizabeth resident.

The first patient at the new hospice was Fannie Iozzi, who last week sat in a chair in her room, behind photographs and cards from her family. The former seamstress and hairdresser talked about her husband, who was a councilman in Linden.

Her son, Jim Iozzi, a school principal in Linden, said his mother developed a great rapport with the staff, including nurses who check in on her even when they are not working.

"They can't do enough for her," he said.

One of his mother's nurses is Corinne Temple, who has worked for the Center for Hope for more than two decades. She said Iozzi in recent days had talked about dying and began calling people in, including staff members, to say goodbye.

"She thanked me for everything I did for her," Temple said. She described Iozzi as "a wonderful woman. She would see me a little down some days and say, 'What's wrong?' She always picked my spirits back up."

Iozzi died on Friday.

Temple said she does not find her job depressing.

"It's sad when people die, but I know they are comfortable and we make it the best we can," she said.

The nurse plans to attend a 50th birthday party for Tanya Landeros, a cancer patient from Plainfield who could not walk when she came to the hospice at the end of February.

"I was bedridden," Landeros said as Temple came to check on her. "Now I'm walking again." The two banter like old buddies and do not leave without first giving each other bear hugs.

Clinical director Nancy Rager said the staff tries to get whatever patients want.

"We had one man who told the doctors to stop all the treatments," Rager recalled. "He said all he wanted was a Texas wiener and a bubble bath."

He came to the hospice and Rager got in her car and returned with two Texas wieners with relish, mustard and chili. The man had his wieners and bubble bath. He died two weeks later.